Coming Alive with Good Design

by Christine MacDonell, member of the ASID Aging in Place Council

In my job as an accreditor of health and human services, I come across many individuals whose main jobs are to improve the quality of life for individuals with limitations that may be physical, cognitive, behavioral or developmental. Recently, I met an occupational therapist who works with our wounded soldiers in the Department of Veterans Affairs. While chatting with her, I mentioned my involvement with ASID. She immediately perked up and began to tell me the story of designing and building her new home, because she wanted to have a home where her daughter with a disability could really “live.”

I asked if she would be interested in sharing her thoughts with a group of designers, and she was more than willing to provide me with information. She also is willing to have discussions with any of you that would be interested. Her name is Nancy Hildreth.  If you would like to communicate with her, send a request to to obtain her e-mail address.  If you do e-mail her, please let her know you read about her experience through an article from ASID.

Nancy and her family were motivated to build from the ground up, because after an extensive search of existing homes they could not find what they needed. The typical layout of the average home does not provide the additional square footage needed in certain areas of the home. Even if they were willing to go through the inconvenience of living in an existing home while there was ongoing remodeling and construction, the result still would not provide for all the designs that they wanted to see.

I was interested if they had considered resale issues as they were building. Nancy’s comment was, “We wanted our house to be very beautiful and comfortable, no matter what the individual's abilities were living there. We wanted people to come and be pleasantly surprised. We did not want to stand out as way different or odd for the street or neighborhood. We wanted to include a full array of options that would cover the needs of anyone using a wheelchair or a person with limited mobility. We also considered the ease of the living space regarding changes related to aging as a resell point. Basically, the home is intended to make everyone’s life easier. The caregiver's needs as well as the person with a disability needs were incorporated into the design plan. We also considered the future use of space. For example, we allowed for adequate space for a roll-in shower in our master bathroom, even though at this time we do not have a roll-in shower in that bathroom. If our daughter was to move into the master bedroom, she could easily have a roll-in shower put in the bathroom with minimal adjustments. We do have a roll-in shower in her bathroom, so someday the house might have two roll-in showers, one on each level.”

I asked her about pinch points or difficulties they might have had along the way. Nancy’s response was that they found “builders wanted us to use their existing plans and when we would bring up ideas for modifications the response was often “What do you need that for?” or “why don’t you just do it this way?” They found a builder who allowed them to use their own architects. The architect they used had a brother who had a physical disability and was flexible and supportive of their needs and desires. One area that might cause builder concerns was the lowering of the foundation, which allowed for no steps at any points entering or exiting the home (a good idea for emergency egress as well). Builders are reluctant to do this because they worry about the risk for water damage, snow melt, etc. to the home. Another was puttingin an elevator, because it requires the square footage for both the stairwell and the elevator in addition to a mechanical room for the elevator.

Nancy and her family are passionate about universal design, because it really changes people's lives. People can engage and participate. When they moved in to their home for the very first time, her daughter could turn on and off the water faucets in the bathroom. In their previous home she had no access to the sink or faucets. Nancy says this may seem insignificant, but her daughter spent her first couple of days going in and out of the bathroom turning on and off the water because she could! Because of the elevator, she could go anywhere in the house, she could turn lights on and off. She could see out of the windows while seated in her wheel chair, whereas in their prior house she could only see the sky.  Because of pocket drawers and levered handles, Nancy’s daughter can open and close doors herself. In the beginning, Nancy remembers her daughter asking if it was OK to go downstairs. She had freedom that she had never had before because of the elevator and needs reassurance and encouragement that she could go anywhere in the house.

For your information, here is how Nancy describes the house: 3602 square feet, four bedrooms, lowered clothes rods for wheel chair access: two master bathrooms, adjustable shower heads, hand held shower, grab bars (reinforced walls for ease of placement for grab bars), one bathroom with a stall shower and one half-bath, a roll-out deck on the main level, panel glass for view, and no steps for safety and security.  A roll-out, walk-out patio on the lower level provides for emergency exit as well as convenience; the entrance from the garage and the front door have no steps and are flush with the threshold. There is no screen on the front door (which can be difficult for chair users to manage), and for safety there are side lights that make it possible to see who is at the door while seated in a wheelchair. Lower window placement throughout to increase viewing access.

Other accessibility features include providing 5'x5' maneuvering space for wheelchair throughout the floor plan and 3' wide doors with lever handles or pocket doors.  Along with the elevator shaft and machine room are an emergency telephone in the elevator and an automatic door. A laundry shoot and laundry room are located next to the accessible bedroom and bathroom where the majority of the laundry is generated, thus eliminating extra travel with linens.  There is a storage closet in the laundry room for equipment as well as an elevated washer and dryer with drawers underneath for wheelchair seat covers and cushions. Storage for additional linens and personal care items is close to the space where they are utilized.

The kitchen includes an elevated dishwasher next to a lower-level mixing area, lowered microwave cabinet, sink with knee space roll under and drains set back for clearance. There is a wall oven, built-in cooktop with front controls and a side-by-side refrigerator. There is roll-out shelving in the cabinets. Electrical outlets were moved up on the wall and rocker-style switches moved down for ease of access.

There are additional square feet in the garage to allow for front storage and wide space for wheel chair lift to come down off a vehicle in the garage.

For Nancy’s daughter, all the design details, both large and small, allow for the first time for independence, exploration and autonomy.

I would like to thank Nancy for her willingness to provide information for all of us to think about and for each of you to appreciate the difference you can make in an individual’s ability to live life!

Christine MacDonnel is Managing Director, Medical Rehabilitation and International Aging Services/Medical Rehabilitation, Commission on Accreditation of Rehabilitation Facilities (CARF).